Abstract

Stylohyoid syndrome (Eagle-Sterling Syndrome) – is a disease, caused by irritation of the nerve, vascular and muscle structures surrounding the elongated styloid process of the temporal bone. The syndrome is manifested by chronic pain in the deep part of the lateral region of the face, on one or both sides, radiating to the root of the tongue, pharynx, palatine tonsil on one or both sides and the ear.

Relevance: in connection with the different zones of pain irradiation in the development of stylohyoid syndrome, there is a need to develop and improve the most optimal methods for its differential diagnosis, with diseases which occur with similar symptoms and the possible exclusion of unnecessary conservative and surgical treatment for patients with unrecognized symptoms of stylohyoid syndrome.

Purpose: unification and improvement of the available, safest methods for the differential diagnosis of stylohyoid syndrome with diseases that occur with similar symptoms (chronic tonsillitis).

Objectives:

1. Development of an algorithm for the doctor’s actions during the initial visit of a patient with symptoms of stylohyoid syndrome and at the same time a visual picture of another disease occurring with similar symptoms.
2. Development of a methodology for examining patients with appropriate symptoms and the presence of a visual picture of another chronic disease, allowing to correctly diagnose and exclude unnecessary prescription of conservative therapy and surgical intervention.
3. Determination of age and gender characteristics of patients with a clinic of stylohyoid syndrome and with the presence of concomitant pathology that can mislead the doctor.

Brief summary of the work.

Otorhinolaryngologists often visit patients, who complain of sore throat, on one or both sides, sensation of a foreign body, with a visual picture of chronic tonsillitis. That allows and encourages the attending physician to perceive the visual symptoms of chronic tonsillitis as dominant. Appropriate treatment is prescribed, after which the desired effect is not achieved, pain symptoms persist.

This should lead the attending physician to the idea that chronic tonsillitis is not the cause of such symptoms.

In 2021, Ukraine adopted a protocol for providing medical care to patients with tonsillitis. On the basis of which there are no indications for surgical treatment in the form of pain in the tonsil on one or both sides. Therefore, when choosing a treatment method in the form of tonsillectomy, several indicators must be taken into account, and not just pain. The stylohyoid syndrome develops predominantly in older age category people. Therefore, considering the patient’s age and several criteria for indications for tonsillectomy, but having the predominant complaint of tonsil pain, we should assume the presence of stylohyoid syndrome and examine the patient accordingly.

Conclusions.

1. As a result of our work, an algorithm for examining such patients has been developed. The following is crucial:

– complaints, which are typical for the stylohyoid syndrome (pain in the tonsil, radiating to the throat, jaw, ear, occiput);

– anamnesis (age of the patient, time from the onset of prolonged pain – few years, pain, regardless of exacerbations of tonsillitis);

– examination and palpation according to the method described above;

– CT diagnostics of the styloid processes with contrast and functional tests;

– if hypertrophy of the styloid process is detected, the solution of the issue of conservative or surgical treatment in the form of its resection through the anterior arch with preservation of the tonsil, or with tonsillectomy if there are indications for tonsillectomy.

2. When deciding on the need for tonsillectomy in people over 35 years of age, it is necessary to take into account the absolute indications described above, and not just pain in the tonsils, which may be a manifestation of stylohyoid syndrome.
3. When addressing age-related patients (according to our observations, 35 years and above) with the described symptoms and the presence of a visual picture of chronic tonsillitis, it is imperative to exclude hypertrophy of the styloid process of the temporal bone.

Key words: elongated styloid process of the temporal bone, vascular-nervous bundle, functional tests, sore throat, pathophysiological mechanisms of pain, tonsillar problem and stylohyoid syndrome, vascular disorders.